Upper limb thrombosis: a third were dead within three months

Clinical bottom line (level 4)

A third of patients with upper limb DVT were dead within 3 months
.Pulmonary embolisms were relatively common after, as was arm swelling.

Hingorani : J Vasc Surg 1997; 26 : 853-860

Expires November 2003

The study

Case series with objective outcomes, not adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

170 patients (aged 9 to 101; mean 68, 61% female) with arm DVT diagnosed by duplex ultrasound (positive if absence of flow and inability to compress vein and hyperechogenic signals in lumen)
All patients received iv heparin so aPTT was 1.5 to 2.5 and then were anticoagulated with warfarin for 3 to 6 months, so INR was 2.0 to 3.0

92% followed for a mean of 13 months (range 0 to 49)
Outcomes studied:

death

symptomatic PE (confirmed on by high probability V/q scan):

arm swelling

The evidence

outcome	time to outcome	number of patients/total number	% (95% CI)
death	a mean of 13 months (range 0 to 49)	/	34% (27% to 41%)
symptomatic PE (confirmed on by high probability V/q scan):	a mean of 13 months (range 0 to 49)	/	7.0% (3.2% to 11%)
arm swelling	a mean of 13 months (range 0 to 49)	/	6.0% (2.4% to 9.6%)

Comments

suspected causes
- central venous line or pacemaker: 65%
- malignancy: 37%
- history of venous thromboembolism: 11%
- current leg DVT: 11%
1.No studies have assessed accuracy of ultrasound for upper limb DVT: however there is little reason to assume it would be much less accurate than for lower limb DVT.

Citation

Hingorani A, : upper extremity deep vein thrombosis and its impact on morbidity and mortality rates in a hospital-based population. J Vasc Surg 1997; 26 : 853-860

Search Terms: ?
Contributor: Chris Ball, November 2001
Reviewer: Clare Wotton

_{Clinical
Question.}

_Patient	_{upper limb DVT}
_{Intervention or Exposure}
_Outcome	_{death, pulmonary embolism, arm swelling}